Provider Demographics
NPI:1619060753
Name:GONZALEZ GARCIA, ORISEL (MD)
Entity Type:Individual
Prefix:
First Name:ORISEL
Middle Name:
Last Name:GONZALEZ GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MANSIONES LAS MESAS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-833-2250
Mailing Address - Fax:787-833-2270
Practice Address - Street 1:#351 AVENIDA HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM BUILDING
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-2250
Practice Address - Fax:787-833-2270
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14837207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16019Medicare UPIN
PR22581Medicare ID - Type Unspecified